Boarding –Tamalpais Pet Hospital
Phone: 415-388-3315
Fax: 415-388-5637
Client:______Species:______Age:_____
Pet Name: ______Breed:______Color:______
Vaccs due: DHLPP____ Bord ____ RV ____ FELV ____ FVRCP ____
*By signing this form, I am giving Tamalpais Pet Hospital the authorization to vaccinate my pet if he/she is not up to date on all vaccinations required to board in this facility; and/or if I am unable to provide the proper documentation proving that my pet is vaccinated.
REQUIRED
Contact Person(while gone): Self Other ______Contact Phone # 1)______2)______
· If a non-emergency medical issue requiring a doctor's attention should arise while your pet is staying with us, would you like to be contacted with an estimate prior to any treatments being preformed? Please initial below:
Yes _____ I can be reached at the phone number(s) provided above.
No _____ I do not require any prior notification and authorize necessary treatments.
Arrival Date: ______Pick Up Date: ______
Preferred Diet: ______
Has your pet eaten today: Yes____ No____
Insulin: Given at ______Amount Given ______Amount Fed ______
Medications or special needs: ______
______
Has your pet been treated for fleas? ______If so, when? ______
Personal items: Leash Carrier Bed Food Meds Other ______
I authorize the following people to walk and/or pick up my pet(s): ______
______
Veterinarian: Name ______Phone ______
Desired treatment while boarding:
______Physical Examination (*may be required at doctor’s discretion, see note)
______Necessary Boosters/Vaccinations (required)
______Treatment for fleas (required if your pet has fleas)
______Senior Care Plan
______Dental Prophy/Polish
______Bath before going home Nail trim
______Medications
______Other ______
*Please note: Your pet’s well being is our major concern. We will do everything possible to make sure your pet stays healthy. If a problem develops, we will call the contact number. If we cannot reach someone we will use our best judgment in providing sound medical care. Signing below indicates that you accept full responsibility for all boarding and veterinary fees.
Signed: ______Date: ______
Veterinary services during nighttime hours, some daytime hours, and/or weekends, is provided at the discretion of the veterinarian in charge.
Continuous presence of personnel may not be provided during these hours.